Fatal Gastrointestinal, Hemorrhage: Clinicopathologic Correlations in 101 Patients

Postgraduate Clinical Notes

“…Obtain optimal conditions for diuresis by establishing complete bed rest, full digitalization, thoracentesis and paracentesis. 4. Utilize multiple diuretic regimens including combinations of parenteral mercurials, benzothiadiazines and antialdosterone agents with acidifying drugs and other substances which potentiate diuretic activity.…”

Mucosal tears at the oesophagogastric junction (the Mallory-Weiss syndrome)

“…However, Chalmers, Zamcheck, Curtins, and White (1952) mention three cases of the Mallory-Weiss syndrome in a series of 101 patients, and Palmer (1952) suspected this diagnosis on clinical grounds in seven of 121 patients admitted with gastrointestinal haemorrhage, although visual confirmation was not obtained. Our own experience suggests that mucosal tears account for a significant proportion of upper gastrointestinal bleeding episodes; after our attention had been drawn to this disorder by Case 1, no fewer than four (Cases 2, 3, 4, and 5) of the next 73 consecutive patients admitted with haematemesis and/or melaena were found to have mucosal tears in the region of the cardia.…”

Acute Upper Gastrointestinal Bleeding in Elderly Persons

“…Nevertheless, some generalizations are possible and are represented in Table 1. In most studies of either younger patients or patients of all ages, duodenal ulceration is the most common cause of significant bleeding, with gastric erosions, esophageal varices, gastric ulcers, esophagitis, and Mallory‐Weiss tears following behind in varying sequence 1 , 2 , 4 , 5 , 18 , 36–40 . On the other hand, in elderly patients gastric ulcer, duodenal ulcer, and gastric erosions tend toward equal frequency, with variable contribution from gastroesophageal varices, esophagitis‐ulceration, and Mallory‐Weiss tears 2 , 3 , 18 , 29 , 41 .…”

“…The propensity of older persons to develop peptic complications without typical pain appears to be aggravated by NSAIDs 18 , 19 , 72 which can mask peptic symptomatology in both young and old 16 , 17 , 73 . It has been well documented that bleeding or perforation from peptic disease with either no or atypical symptoms, whether associated with NSAIDs or not, is particularly likely to have a high mortality rate 29 , 36 , 41 , 49 , 71 , 73 , 74 …”